Physician practices can expect Medicare Advantage (MA) plans to step up quality of care efforts. The health care reform law incentivizes MA plans to boost quality ratings by 2012.
The Kaiser Family Foundation (pdf) wrote an issue brief about the new bonus program. MA plans will receive extra payments when they achieve four or more quality stars out of five. The plans are graded on effectiveness, a consumer assessment, a health outcomes survey and CMS administrative data. CMS data includes statistics on appeals, audit results and customer service.
Current rankings show some states have MA plans with better scores than other states.
"The share of Medicare Advantage enrollees in plans with four or more stars varies across states, ranging from 67% of all Medicare Advantage enrollees in [the District of Columbia] to zero percent in five states [(Arkansas, Mississippi, Montana, Nebraska and Vermont)], the Kaiser report states. "In 27 states, less than 10% of Medicare Advantage enrollees are in contracts with four or more stars, and in three of these states [(Nevada, Delaware, and Florida)] more than 80% of Medicare beneficiaries have access to a highly-rated plan."